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It has been suggested that over the last decade interest in and delivery of psychological therapy for people with learning disabilities have increased (Beail et al, 2005). While the literature continues to highlight the need for further evidence of its effectiveness (Willner, 2005) there is a general ‘swell of opinion’ that psychological therapy for individuals with learning disabilities is helpful (Mason, 2007). A component of psychological therapy that is generally considered to be universally important is the quality of the relationship between therapist and client (Clarkson, 2003). However, in the relatively new field of psychological therapies for people with learning disabilities, there remains a poor empirical and theoretical understanding of the role and potential complexities of the therapeutic relationship. The paper explores some of the existing literature in this field. It highlights the limited empirical evidence before exploring some of the common themes outlined so far in the clinical literature. The paper concludes with some suggestions for future research in this area.

This study aims to explore the applicability of Bordin’s model of therapeutic alliance in talking therapies for people with intellectual disabilities.

People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client.

People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin’s model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them.

This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable.

Very few studies have explicitly examined the client’s view of therapy alliance.

This paper reviews the literature on therapeutic process specific to sexual offender treatment. The general clinical literature emphasises the importance of therapist style, the client's perceptions, the therapeutic alliance and cohesiveness. We highlight the importance of therapist characteristics, group cohesion and emotion in effective treatment of sexual offenders. Implications for programming and research are emphasised.

Despite a long history of psychodynamic therapy interventions with people with learning disabilities and anger problems, there is little evidence that suggests that this approach is effective. The present case study explored 18 pychodynamic therapy sessions with an adult with mild learning disabilities and anger problems, investigating therapy outcomes and progress along a nine‐stage Malan (1979) model, as well as analysing therapeutic interactions leading to therapy progression. The patient's progression along Malan stages was explored by a thematic analysis matching therapy sessions to the Malan model. The investigation of therapeutic interactions was achieved by discourse analysis of those therapy sessions indicative of Malan‐Stage progression. The results are discussed and suggestions for future research and practice implications are made.

From the mid-1980s to the mid-1990s, several prominent feminist legal scholars made a case for “difference feminism.” Inspired by psychologist Carol Gilligan’s classic text, In a Different Voice, these scholars argued that social relationships, caring, and the emotions should be recognized as important to jurisprudence and legal regulation. Today, difference feminism is no longer a dominant movement within legal scholarship, but reformers are bringing “mindfulness,” “emotional intelligence,” and attention to relationships into law and business – a development dubbed “therapy culture” by its critics. This essay describes some of the manifestations of therapy culture in law and argues for more feminist engagement.

Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may be drawn from an extensive examination into the usage of the term ‘psychopathy’ in scientific research literature, in theoretical development from various psychological schools of thought, in the practice of therapy and in assessment. The central issue for the authors of this article is the inability of severely psychopathic patients to commit to the patient‐therapist relationship. Attachment theory and mentalisation‐based treatment are used here to define the cause and nature of this inability, which is incurred in very early childhood. These two models can aid in the development of more dynamic definitions of psychopathy, better suited to dynamic therapy formats.The ways in which psychopathy is defined partly account for a number of problems encountered in the practice of therapy. The authors assume that the treatment of psychopathy should be interactional and should match patients' individual levels of psychological development and mentalisation; highly psychopathic patients often perceive others as objects, ie. as part of the context, not as subjects, ie. autonomous personalities.The authors propose to conduct further research in order to verify the validity of their hypothesis. They also put forward a number of suggestions for therapy formats with a view to establishing effective working relationships with psychopathic patients.

Working across languages is playing an increasingly important role in the delivery of mental health services, notably through psychotherapy and psychological therapies. Growing awareness of the complex processes that ensue in working across languages, including the presence and role of an interpreter, is generating new conceptualisations of practice, but there is a need now to evidence how these impact on service users. The paper aims to discuss these issues.

This paper discusses the model for working with interpretation developed by Mothertongue multi-ethnic counselling service, which conceptualises the therapeutic process as working within triangular relationships consisting of service user, therapist and interpreter. Second, the paper discusses the qualitative, practice-near methods applied in, and findings from a pilot study to evaluate the interpreter's role.

Three patterns of response to interpreters were identified: negative impacts on the therapy, the interpreter as conduit for therapy and the therapist and interpreter jointly demonstrating a shared enterprise. It is concluded that the method and findings of the pilot justify a larger study that will further evaluate the experiences of service users and continue to develop and test conceptualisations for best practice.

Working across languages is now recognised as an increasingly important aspect of therapy in contexts where migration has created new demographics. This paper contributes to the discussion of working therapeutically with people with mental health difficulties across languages. Its originality lies, first, in the discussion of a new clinical approach to working with interpreters, and second in the methods used to access the views of service users about their experiences of interpreters.

While there is general agreement in the literature regarding the importance of the therapeutic alliance (TA) in psychological interventions with people, the forensic context raises some unique challenges. The purpose of this paper is to discuss how these challenges are managed within a therapeutic context.

This paper consists of a literature review examining the following: the significance of the TA in interventions with forensic clients, especially men who have committed a sexual offence and the impact on treatment efficacy and change; therapist characteristics as well as some of the obstacles and challenges present in a correctional setting, which can impact on the TA and; the role of transference and countertransference in relation to these forensic clients.

Through the literature review, there is a discussion regarding how some of the common obstacles within correctional settings can be overcome, and how certain therapist qualities should be interpreted.

This paper will discuss some of the practical applications of certain recommended therapeutic factors within a correctional setting, challenging some of the common misconceptions and limitations. Furthermore, transference and countertransference, topics which are seldom discussed, will be considered in this paper.

A range of adaptations and therapy processes have been explored in relation to therapy with people with intellectual disabilities; however, there remain a few areas of therapy practice that have not yet been considered in depth. This study aims to report the results of an online survey of the practice of therapists working with people with intellectual disabilities in managing endings in therapy.

Thirty-one therapists working with people with intellectual disabilities responded to an online survey. The data were analysed using reflexive thematic analysis.

Three superordinate themes were identified: Theme 1 was “preparing for a therapeutic ending” with subordinate themes of “planning early”, “providing boundaries” and “validating feelings”; Theme 2 was “providing a therapeutic ending”, with subordinate themes of “a collaborative decision” and “fostering growth”; and the third theme was “post-ending issues” in which participants acknowledged a “spectrum of emotion”, and, in the case of difficult endings, a sense of “unfinished business”.

This is the first systematic exploration of therapy endings as described by therapists working with people with intellectual disabilities. The authors discuss implications for practice and further areas of research.